Testing advice

Self-collection of samples for NAAT testing

Vaginal swab: instruct the patient to insert the swab into the vagina like a tampon and then remove and place into the transport tube.

Rectal swab: instruct the patient to insert the swab into the anal canal 2-4cms and then remove and place into the transport tube.

FPU (First pass urine): Collect approximately 20 ml (1/3 of the standard urine jar) of the first part of the urine stream in a specimen jar at the time you are consulting the patient. The patient does not need to have held their urine for more than 20 minutes prior to specimen collection. A midstream urine (MSU) or early morning specimen (i.e. first void urine) are not required for NAAT.

Click here for information on how to describe self-collection technique to a patient.

Self-collection of samples for NAAT testing

Vaginal swab: instruct the patient to insert the swab into the vagina like a tampon and then remove and place into the transport tube.

Rectal swab: instruct the patient to insert the swab into the anal canal 2-4cms and then remove and place into the transport tube.

FPU (First pass urine): Collect approximately 20 ml (1/3 of the standard urine jar) of the first part of the urine stream in a specimen jar at the time you are consulting the patient. The patient does not need to have held their urine for more than 20 minutes prior to specimen collection. A midstream urine (MSU) or early morning specimen (i.e. first void urine) are not required for NAAT.

Click here for information on how to describe self-collection technique to a patient.

HIV status should be confirmed in anyone reporting a history of injecting drugs. Annual testing in those with an ongoing history of injecting drugs is recommended.Repeat test if patient exposed within previous 12 weeks (window period).

PWID are at high risk of hepatitis B acquisition, if not vaccinated and have not been previously exposed to the virus. Vaccinate if not immune. Serological testing after completing vaccination is recommended.

Hepatitis C status should be confirmed in all people reporting a history of injecting drugs. Annual testing in those with an ongoing history of injecting drugs is recommended. Hepatitis C is not considered an STI except between HIV infected men having unprotected anal sex.If antibody positive, test for hepatitis C NAAT to determine if patient has chronic hepatitis C.

NAAT – Nucleic Acid Amplification Test

Specimen collection

Clinician collected for NAAT/culture/microscopy

Urethral swabs for microscopy should be collected when the patient has not urinated for at least 1 hour and only if the patient has frank urethral discharge. Squeeze the urethra to express the discharge and collect on urethral swab. It is not necessary to insert the swab into the urethra.

Rectal swabs should be collected by inserting a sterile swab 2-4cms into the anal canal and moving the swab gently side to side for 10-20 seconds.

Pharyngeal swabs should be collected from the tonsils and oropharynx.

High vaginal swab of vaginal discharge smeared onto a glass slide, air dried and sent for microscopy. Swab inserted into transport medium for culture.

Self-collection of samples for NAAT testing

Vaginal swab: instruct the patient to insert the swab into the vagina like a tampon and then remove and place into the transport tube.

Rectal swab: instruct the patient to insert the swab into the anal canal 2-4cms and then remove and place into the transport tube.

FPU (First pass urine): Collect approximately 20 ml (1/3 of the standard urine jar) of the first part of the urine stream in a specimen jar at the time you are consulting the patient. The patient does not need to have held their urine for more than 20 minutes prior to specimen collection. A midstream urine (MSU) or early morning specimen (i.e. first void urine) are not required for NAAT.

Click here for information on how to describe self-collection technique to a patient.

Clinical indicators for testing

Testing for HIV, hepatitis C (and hepatitis B if non immune) should be offered to all PWID reporting use of shared injecting equipment (needles/syringes/spoons etc). This should be arranged after the window period for the relevant infection.

It is not recommended to routinely test for herpes and genital warts with serology. Consider testing for herpes and genital warts only if there are clinical signs and symptoms.

References

Centres for Disease Control and Prevention. Integrated Prevention Services for HIV Infection, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis for Persons Who Use Drugs Illicitly: Summary Guidance from CDC and the U.S. Department of Health and Human Services MMWR 2012 61(5) 1-48 http://www.cdc.gov/mmwr/pdf/rr/rr6105.pdf

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